title: Patient-experienced effect of an active implementation of a disease management programme for COPD - a randomised trial.
abstract: BACKGROUND
  People living with chronic disease currently account for the majority of the total healthcare costs. The Central Denmark Region implemented a disease management programme (DMP) for chronic obstructive pulmonary disease (COPD) in 2008. This presented an opportunity to examine the effect of an evidence-based, planned and proactive implementation of a DMP compared to the usual implementation strategy.
  
  
  METHODS
  We performed a block- and cluster-randomised controlled trial with two groups and an extra external control group. The primary outcome was patients' assessment of their care after using an active implementation model for a DMP for COPD measured with the Patient-Assessment-of-Chronic-Illness-Care (PACIC) instrument. At baseline, questionnaires were sent to 2,895 patients identified by an algorithm based on health registry data on lung-related contacts to the healthcare system. Patients were asked to confirm or refute their diagnosis of COPD. Of those who responded, 1,445 (72.8%) confirmed their diagnosis. PACIC data were collected at baseline and at a 12-month follow-up for 744 (51.1%) patients.
  
  
  RESULTS
  Comparing the three groups after the implementation of the DMP, we found a statistically significantly higher change in the PACIC score in the intervention group than in the control groups. No statistically significant differences were found between the control and the external control groups in any of the dimensions.
  
  
  CONCLUSIONS
  Reinforcing the role of general practice as coordinator for care-and self-management-support with an active implementation of a DMP for COPD made patients score higher on the PACIC instrument, which indicates a better experience of the received healthcare.
  
  
  BACKGROUND
  NCT01228708.
authors.affiliation: The Research Unit for General Practice Aarhus, Aarhus University, Aarhus C 8000, Denmark. m.smidth@alm.au.dk.
authors.forename: Margrethe
authors.initials: M
authors.lastname: Smidth
authors.forename: Frede
authors.initials: F
authors.lastname: Olesen
authors.forename: Morten
authors.initials: M
authors.lastname: Fenger-Grøn
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome